Televising kids' heart operations drawing rapt audience of doctors

In a darkened Chicago hotel ballroom, hundreds stare intently at four giant video screens showing a Miami cardiologist probing an 11-year-old patient's heart, which has a hole in it.

Suddenly, a man in the audience jumps up, strides to a microphone and asks for a video replay of the dye being injected into the young patient's beating heart.

"I suspect a second hole there," says Dr. Wolfgang Radtke of the Children's Hospital of Pittsburgh. A ballroom camera catches Radtke's face and insets it on the screens, along with the child's beating heart and video of Dr. Evan Zahn at Miami Children's Hospital, who is doing the procedure with cameras and probes, avoiding open-heart surgery.

Later, the ballroom audience is polled on whether they detect two holes or one in the patient's heart. There was no consensus, but it gave everyone a good example of the complexity of diagnosing cardiac abnormalities.

"It takes a lot of organization," said Dr. Ziyad Hijazi, the University of Chicago medical professor who co-directs the annual pediatric cardiology conference. "You have the patient's life on the table."

Such conferences are made possible with interventional cardiology technology that allows doctors to treat heart problems in a very visual way.

Doctors look at screens displaying images made from X-rays or ultrasounds as they guide tools through catheters inserted in blood vessels to repair cardiac damage.

Many cardiac catheterization labs now come equipped with cameras and fiber optics intended to send images over long distances for teaching and diagnostics.

Technology to make coronary repairs without open-heart surgery is a multibillion-dollar industry for adult patients, who routinely get procedures using balloons, stents or other devices inserted through blood vessels. But for children with heart problems, interventional cardiology is just a small subspecialty that does not attract huge industry support.

"Most of the industry focuses on adults," said Dr. William Hellenbrand, a Columbia University pediatric cardiologist who co-directed the meeting with Hijazi.

Often, doctors who treat youngsters must modify equipment and techniques designed for adults. In a field in which technology advances are measured in months, pediatric specialists believe they must help one another keep aware of new therapies.

"We adapt tools to work with smaller patients," said Hellenbrand. "Clearly, there's a revolution in technologies to provide treatments while avoiding open-heart surgery."

This autumn's conference was the eighth organized by Hijazi, who already is planning next year's meeting in Buenos Aires.

The international aspect to the effort is helpful, he said, because physicians often learn about new techniques and tools not approved for use in the United States that may be used in Europe or South America.

Audio Visual Systems and Support Inc., a privately held company based in Ft. Myers, Fla., televises the cardiac procedures, transmits signals to satellites and coordinates the technical side of the cardiac conferences.

"We handle audio/video for a lot of companies," said company owner Mike Fitzgerald. "We do mostly corporate events--national sales meetings and some drug rollouts. But this conference is our biggest challenge."

Having crews in up to five locations on different continents at the same time televising cardiac procedures is as challenging as covering a sporting event for commercial TV, Fitzgerald said.

"Sometimes the docs have to wait on us, and sometimes we have to wait on the docs," he said. "But when you're having technical problems at one location, you can always cut to another one."

The video crew tapes the procedures, so if a physician does something important in one location while the conference TV is focused elsewhere, an instant replay can be rolled later to bring the audience up to speed on what happened, Fitzgerald said.

"It feels good to be part of something that helps people," he said.

"A year or two ago, one of the docs lost a balloon in a patient and was searching for it. ... A physician in the audience helped them find it and retrieve it from the patient," he said.

It costs hundreds of thousands of dollars to pay for the TV crews and equipment needed to put on three days of educational cardiology, said Hijazi.

The physicians organize the conferences themselves without government financial aid, he said.

Some interventional cardiac-equipment vendors pay to display their wares at each conference, but most of the funding for the events comes from the physicians and technicians who pay to attend.

"My own hospital gives some money to cover expenses," he said. "We just want to break even. It takes a lot of organizational skills. You have a patient's life on the table.

"Luckily, we never lost anybody on camera. But we could. This is real life."